HomeMy WebLinkAboutMiscellaneous - 457 BEAR HILL ROAD 4/30/2018 457 BEAR HILL ROAD
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
yes ❑ no ❑ do not know
6. How old is your sewage disposal system? Q 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes fl no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes ❑ no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 0 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year --
Season(s) of the year `
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
r
❑ Check here if your lawn is maintained by a professional landscape contractor.
N r " ERS HE 13.SID ESQ TS QUESTIONNAIRE
1. Name
2. Street Address y > _71
O 3. How many members are in your household? a
i
4. `Float type of sewage disposal system do you have? a
i
❑ cesspool
❑ septic tank and leaching area
tri connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
yes ❑ no ❑ do not know
6. How old is your sewage disposal system? [K 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. has your sewage disposal system been rebuilt or repaired?
❑ yes no ❑ do not know
If yes, approximately how long ago? years. What was done?
S. glow frequently is your sewage disposal system pumped out? annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never -
9. Have you had any Problems
with your sewage disposal system? Yes no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. lis,vv, many of each appliance are connected to your sewage disposal system?
�,shing machine rr dishwasher garbage disposal
dehu.midif er drain sump pump toilet
roof/pa-ement drains showerlbathtub
11. please sfate the brand and type (liquid or powder) of detergent you use for:
dishwashers
clotheswasher t f
12. hoes your property have a lawn? [2f- yes ❑ no
If yes, ai-proximately what size?
El less `'.an 1/4 acre ❑ 1/4 acre ® lh acre ❑ 3/4 acre ❑ 1 acre
❑ morf han 1 acre (Specify) acres
13. How oft- ado you fertilize your lawn?
No. of ol :cations per year Z
Season;€ the year _5 P,r' PA= k
14. 1' Fase S. the brand and type (liquid or granular) of lawn fertilizer you use:
❑ is here if your lawn is maintained by a professional landscape contractor.